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Published on: March 28, 2025
Prompt surgery is effective for acute type A aortic dissection with cerebral ischemia
Yunxing Xue1,2,3, Xinlong Tang1,2,3, Xiyu Zhu1,2,3
1Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
Insights
Prompt surgery for acute type A aortic dissection (aTAAD) with cerebral ischemia (CI) improves outcomes. A duration longer than 12.75 hours between CI symptoms and surgery, and preoperative coma, predict worse results.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Emergency Medicine
Background:
- Acute type A aortic dissection (aTAAD) is a life-threatening condition.
- Preoperative cerebral ischemia (CI) in aTAAD patients is common and associated with high mortality.
- Optimal timing and treatment for aTAAD with CI remain unclear.
Purpose of the Study:
- To analyze outcomes and identify risk factors in aTAAD patients with preoperative cerebral ischemia (CI).
- To determine the safe duration of preoperative CI before central repair surgery.
- To evaluate the impact of preoperative coma on postoperative outcomes.
Main Methods:
- Retrospective review of 1,173 aTAAD patients from January 2011 to December 2019.
- Comparison of 131 patients with preoperative CI (CI group) versus 1,042 patients without CI (non-CI group).
- Analysis of surgical outcomes, mortality, and risk factors using ROC curves to determine safe CI duration.
Main Results:
- The CI group was older and presented with lower rates of typical pain symptoms but higher rates of hypotension and tamponade.
- Mortality was higher in the CI group (28.2%) compared to the non-CI group (15.9%), especially in patients not receiving central repair.
- Preoperative coma was the strongest predictor of postoperative cerebral complications, and a CI duration over 12.75 hours was associated with worse outcomes.
Conclusions:
- Prompt central repair surgery is effective for aTAAD patients with preoperative CI.
- Preoperative coma and a CI duration exceeding 12.75 hours are significant predictors of adverse outcomes.
- Timely surgical intervention is crucial for improving survival rates in aTAAD with CI.
Background:
Acute type A aortic dissection (aTAAD) with preoperative cerebral ischemia (CI) is common and lethal, but the timing and treatment method remain uncertain. We retrospectively reviewed our aTAAD patients with CI and analyzed the outcomes and related risk factors.
Methods:
From January 2011 to December 2019, 1,173 patients diagnosed with aTAAD from Nanjing Drum Tower Hospital were enrolled. Among them, 131 patients had CI preoperatively (CI group), and 1,042 patients were in the non-CI group. One hundred eight in the CI group and 984 in the non-CI group received central repair surgery. Fifteen patients had postoperative cerebral complications (CC) and 93 had non-CCs. ROC curves were used to identify the safe duration of preoperative CI.
Results:
The CI group was older (56.3 vs. 53.2 years, P=0.013) and had lower rates of pain, chest pain and back pain (77.9% vs. 94.4%, 75.4% vs. 87.5% and 30.8% vs. 42.3%, respectively) than the non-CI group. The CI group had a higher rate of preoperative hypotension and tamponade (13.7% vs. 6.0%, 26.9% vs. 10.4%, respectively; P=0.000). More patients in the CI group did not receive central repair surgery, and the CI had higher mortality (28.2% vs. 15.9%). CI without central repair surgery was a strong risk factor for mortality. CI patients with CC after central repair had a higher mortality, and preoperative coma was the strongest risk factor for postoperative CC.A duration between CI symptoms and central repair surgery of less than 12.75 hours is recommended.
Conclusions:
Prompt surgery is effective for aTAAD with CI, and preoperative coma and a safe duration longer than 12.75 hours would predict worse outcomes.
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